Psychosis and Hearing Voices

Because I work as a Psychiatrist, some people think that a trip to see me is not complete without the archetypal question, “Do you hear voices”. However, though I do usually cover this are at some point, that question itself is next to useless.

Some people will run a mile – especially if they actually suffer from something like OCD [page 24] and just FEAR they are going mad. Others will have voices which for them are quite normal – about 1% of the UK population chronically hear voices and are not ill at all. And the group who you might think I am interested in (those with Schizophrenia) do not all hear voices and (as a diagnostician) I am interested in far more than just hearing a voice.

Causes for Voice Hearing

Normality: Hearing voices or complex noises can be a normal experience and people live otherwise healthy lives. If it gets bad, the Hearing Voices Network (www.hearing-voices.org) have a helpful website with links to books and self-help groups all around the country. This resource can also be useful for some of the people who hear voices for the reasons listed below.

Split-Mind: The literal meaning of the word schizophrenia is ‘split brain’ but this is a misnomer – this is not what is happening in schizophrenia. But there are people whose mind is ‘split’ who hear voices. This may have occurred as a result of awful trauma when young such as sexual abuse – and our natural defence mechanism is to split off that awful memory into a hidden part of the brain. But humans don’t do well with hidden bits, and it tries to get out – some times as flashbacks, but sometimes as the voice of the abuser saying nasty things like “You are dirty/horrible/useless.”

Low self-esteem: When our mood is chronically lowered, not typically due to depression which is episodic, but due to low self-worth; we can begin to hear a voice that resonates with our mood. It is more like an audible conscious stream of negative and critical comments: “You are useless. You are fat. I can see why no-one wants to be your friend…”

Substance Misuse: If you use alcohol heavily, or other street drugs like amphetamines that stimulate dopamine [see below] you will be likely to hear voices. In chronic alcohol use, the voice is similar to in low self-esteem above. In amphetamine intoxication it can be anything from hearing police sirens to thinking you are in space and ‘Ground Control’ is trying to reach you…

Severe mental illness: People with schizophrenia will experience all kinds of voices. General paranoia is common, but psychiatrists are particularly interested in three types of voice: Two or more people talking about you, a voice commentating on your actions, hearing your own thoughts read out aloud. These voices are strongly suggesting of schizophrenia rather than other causes. Voices are also sometimes heard in other severe mental illnesses such as bipolar affective disorder, advanced dementia or very severe depression.

Schizophrenia

Though a fairly uncommon cause of hearing voices, this is worth an extra mention due to the fact that people know almost nothing about it – yet think they know enough to pass judgement. It is a very severe mental illness and needs urgent management by a psychiatrist supported by a well-equipped team. You will probably be offered anti-psychotic medication (see page 32), as an abnormality of brain chemistry [specifically dopamine transmission] in the frontal and temporal lobes is thought to be a key feature. However, it is never just about medication and should ALWAYS be accompanied by some kind of support (according to how much you need), some kind of talking therapy (to reduce the anxiety associated with the symptoms) and a crisis plan (of things to do if symptoms worsen). Some people may need to come into hospital for a while.

However, it is not something to be afraid of. Sadly, people have a negative image of schizophrenia – largely thanks to films like ‘One flew over the cuckoo’s nest’ and ‘Me, myself and Irene’. The first is woefully out of date and even then inaccurate, the second is about multiple personality disorder and psychopathy – things completely unrelated to schizophrenia even if Jim Carey doesn’t know this. Also, Christians can need reminding that Schizophrenia is NOT demon possession – most of the cases of demon possession in the Bible are completely unlike Schizophrenia and even the ‘Gerasene Demoniac’ in Mark 5 is pretty far off the mark. For a more complete discussion on this topic, look at the Mind and Soul website (www.mindandsoul.info) and search for ‘demon’.

Schizophrenia affects 1% of the population at some point in their lives and treatment can last for several years. This means that there are lots of people on treatment and you would never know – anymore that you could tell a person with diabetes was on insulin. People with Schizophrenia (and please lets call them this, not ‘schizophrenics’ or ‘nutters’) are more likely to get hit that hit you – they are not typically violent, especially when well. In fact, in my experience, I have typically found them to be amazing and resourceful people who have to live with a severe illness that affects something very close to their core. Perhaps you or I would do well to meditate on this before we jump to any conclusions.

Cannabis and Schizophrenia

It is well known that smoking too much grass can make you a bit edgy – even paranoid. But this typically settles. Opinion is divided as to whether heavy use will actually CAUSE schizophrenia. Statistically, there is a dose-related correlation between use and later Schizophrenia. However, it could be that it just brought to the fore something that was going to develop anyway. Cannabis is also used by some people to take the edge of voices in the short-term. However, unfortunately it tends to make voices worse in the long term. It can also be a ‘gateway’ to other more serious drugs like amphetamines and heroin.

Students and first episodes of psychosis

The peak age of onset for Schizophrenia is in the early twenties so it may well develop at University. It is triggered (though not caused) by stress, so can particularly emerge in Freshers’ Week – most Universities will see several new cases each September. It may also emerge more slowly as a person struggles to adapt to the new environment.
A ‘typical’ person developing Schizophrenia (and this is only typical) may have given some warning signs early on such as being uncharacteristically rigid in their thinking or having a few ‘BLIPS’ (brief limited intermittent psychotic symptoms) of voices or paranoia that last for a few days then back to normal. There may well be a close family member with the illness. They may be using drugs, not as a cause for the problem, but to help them cope with symptoms. They will most likely be self-isolating and you will see their life begin to deteriorate on a number of levels (appearance, work, hygiene) not just in what they say and think.

This is one of the situations where you should encourage the person to seek help themselves but, if they will not, you may want to go over their head as early treatment is more effective and can help prevent a severe breakdown later.